By SUZANNE KASHUBA

“I think I began to appreciate the truths of what my patients might experience and felt myself even just today be more considerate and empathetic toward them.”

Karim Velji, first-year family medicine resident

For one eye-opening afternoon, UB resident physicians and
medical students got a small taste of the challenges and
frustrations patients living in poverty or on a low income face
every day.

Forty family medicine residents and 15 medical students recently
took part in a simulation exercise designed to give them a
realistic idea of what it takes to make ends meet when financial
resources are scarce.

Participants took on new identities as they personified written
scenarios describing their new names, life circumstances and
available resources.

Their new personas may have just lost a job or been deserted by
the family breadwinner. They may be homeless or receiving public
assistance. They may be a senior citizen on Social Security, or a
grandparent raising grandchildren.

Despite diverse roles, the personas all had the same challenge:
to provide basic necessities for themselves and their families
throughout a simulated month — four 15-minute
“weeks.”

The “families” were both helped and hindered by
various community service providers, portrayed by volunteers that
included UB faculty and staff members. Among the providers, for
example, were a police officer, pawnbroker, grocer, landlord, a
payday lender, social service worker, employer, child care worker
and teacher, as well as an “illicit activities person”
who may sell drugs or steal.

As the personas moved around the volunteer-staffed tables
representing services, they tried their best to navigate the
obstacles of daily existence — but found it wasn’t
easy.

As volunteer Pam Coniglio, clerkship coordinator for family
medicine, observed, “the residents really were stressed,
frustrated and angered by the system and their inability to easily
get the things they needed to maintain their households and their
jobs.”

The experience “reinforced the need for everyone to take a
step back before making assumptions,” said volunteer Karen
Devlin, family medicine program coordinator for predoctoral
education. “You need to walk a mile in someone’s shoes
before forming an opinion.”

Kim Griswold, associate professor of family medicine and
psychiatry, described the experience as
“fantastic.”

“There were real interactions,” said Griswold, who
served as a volunteer and also led a debriefing session for
participants focused on implications for patient care.

This experience “broadens horizons about what patients
experience,” she said. It helps participants understand the
numerous barriers their patients may face, including financial and
time constraints, transportation needs and language
difficulties.

One participant was forced to “visit” the Department
of Social Services three times before he met with his caseworker
because he kept arriving as the office was about to close.

Noted first-year resident Karim Velji shortly after completing
the exercise: “I think I began to appreciate the truths of
what my patients might experience and felt myself even just today
be more considerate and empathetic toward them.”

Paradoxically, although one of the simulation tables represented
a medical station, the exercise suggests that people in poverty may
forgo needed health care. “Only one person went to the
clinic,” Griswold noted. “People didn’t have time
to go to the doctor. They need us, but can’t get
there.”

Volunteer Daniel W. Sheehan, clinical associate professor of
pediatrics and chief of pediatric pulmonology, admitted that he has
been “clueless to many struggles that my inner-city patients
and families face.”

In the future, he said, he will “take the time to delve
into social barriers to adherence and self-care.”

Buffalo typically ranks among the poorest large cities in the
nation. Based on recent U.S. Census Bureau data, it is the
fourth-poorest city for families, with 26.4 percent of families
living below the federal poverty level. Median household income
amounted to slightly more than $30,500 per year from 2008 to
2012.

The exercise helped participants understand urban medicine in
particular and “opens their eyes to the poverty rate and low
income levels in Buffalo,” Griswold said.

Although third-year medical students have been participating in
the poverty-simulation exercise for a few years, this is the first
time it has been offered to UB medical residents.

UB’s Office of Graduate Medical Education and Department
of Family Medicine residency program collaborated with the United
Way of Buffalo and Erie County to conduct the training
experience.